Individual
MARISOL C CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1138 LEXINGTON RD STE 290, GEORGETOWN, KY 40324-9672
(502) 863-0721
(502) 863-6104
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
49101
KY
207QA0401X
Addiction Medicine (Family Medicine) Physician
49101
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100443440
—
KY
Enumeration date
01/10/2007
Last updated
08/17/2023
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